Communication amplification device comprising retention elements for an implantable capsule

ABSTRACT

This disclosure relates to a communication amplification device for an implantable capsule, in particular for an autonomous cardiac stimulation capsule. The amplification device comprises a first holding element and a second element configured to hold the implantable capsule. The first holding element is configured to receive the distal end of the capsule and the second holding element is configured to receive the proximal end of the capsule. The first holding element comprises a communication amplification antenna configured to couple to a distal electrode of the capsule.

CROSS-REFERENCE TO RELATED PATENT APPLICATIONS

This application is a 371 U.S. National Application of InternationalApplication No. PCT/EP2016/080877, filed Dec. 14, 2016 which claims thebenefit of and priority to French Patent Application No. 1562572, filedDec. 17, 2015, which is incorporated herein by reference in itsentirety.

BACKGROUND

The invention relates to “active implantable medical devices” as definedby Council of the European Communities Directive 90/385/EEC of 20 Jun.1990, and more specifically to pacemaker implants for continuouslymonitoring heart rate and, if necessary, for delivering electricalpulses to the heart for stimulation, resynchronization, and/ordefibrillation, in the event heart arrhythmia is detected by the device.

The invention relates more particularly, but non-limitingly, to suchdevices that are in the form of a self-contained or “autonomous” capsuledesigned to be implanted in a cardiac cavity (right or left ventricle oratrium). Such capsules are devoid of any mechanical link or connectionto a main device that is either implanted (such as a stimulation orpace-making pulse generator) or not implanted (an external peripheralsuch as a programmer or monitoring device for remotely monitoring thepatient), and, for that reason, they are referred to as “leadlesscapsules” to distinguish them from sensors that are disposed at thedistal end of a conventional lead, through the entire length of whichone or more conductors extend that connect the electrode or the sensormetallically to a generator connected to an opposite, proximal end ofthe lead.

Two categories of autonomous capsules exist. The first category concernsendocardial capsules that are placed in one of the cardiac cavities. Thesecond category concerns epicardial capsules that are fastened to theouter wall of the myocardium, which outer wall is also known as the“epicardium”.

Endocardial capsules are of cylindrical shape, e.g. they have a“capsule” shape as shown in FIG. 1, so that they can be insertedlongitudinally by an in situ implantation accessory, such as a catheterfrom the venous or arterial system of the patient.

Fastening means are provided at the end of the capsule for the purposeof anchoring the capsule to the desired stimulation or pace-making site.

An implantable capsule as described in Document US 2008/088397 comprisesa body that houses the main component elements of the device (electroniccircuits, energy source, stimulation or pace-making electrodes, etc.),and a base secured to the body and rigidly supporting fastening meansfor fastening to the wall, in particular to the endocardial wall.

Such capsules further comprise a communications device making itpossible to communicate with an external device, e.g. a programmer, byradiofrequency or via the human body, in particular by Human BodyCommunication (HBC) or “intra-body communication”, or by any othersystem, and also to communicate with one or more other implants, fortransmitting and receiving information.

As regards implantable autonomous capsules that, for example, use theHBC communication protocol, it is difficult to communicate with suchcapsules before they are implanted in the patient. For example, onesolution consists, during manufacture of an implantable autonomouscapsule, in immersing it into a conductive liquid and in also immersingtwo electrodes into the liquid, which electrodes are connected to anexternal monitor in order to communicate with the capsule. The liquidis, for example, saline of the 0.9 grams per liter (g/l) sodium chloride(NaCl) type.

However, that solution making it possible to communicate with theimplantable autonomous capsule suffers from drawbacks. Firstly, theconductive liquid is not representative of the tissues of the humanbody. Secondly, communication between the capsule and the externalmonitor is dependent on the conductivity of the electrodes and of thewires connecting the electrodes to the external monitor.

Such an implantable autonomous device that uses the HBC communicationprotocol also suffers from the drawback that it is impossible to checkwhether the system of the capsule is operating properly and to programthat capsule once the capsule has been sterilized and placed in asterile bag.

Checking the system of the capsule is operating properly and programmingit can only be achieved by the surgeon, using that immersion method, atthe time at which the capsule is being implanted, which gives rise topreoperative risks and additional manipulations of the implantableautonomous capsule that are undesirable when implanting said capsule.

SUMMARY

An object of the present invention is to propose a communicationamplification device for an autonomous implantable capsule that makes itpossible to avoid having to immerse the implantable capsule in order tocommunicate with it.

This aspect is particularly critical, insofar as the sterility of theautonomous implantable capsule must be preserved, and it is essential tohave good communications between the autonomous implantable capsule andthe external device, in order to check the capsule is operating properlyand in order to program it.

More specifically, and to this end, the invention provides acommunication amplification device for an implantable capsule, inparticular for a pacemaker autonomous capsule, the capsule comprising,at its distal end, a distal electrode table to come into contact withthe tissue of a wall of an organ of a patient.

In a manner characteristic of the invention, the amplification devicecomprises a first holding element and a second holding element forholding the implantable capsule, the distal end of the capsule beingable to be inserted in the first holding element and the proximal endbeing able to be inserted in the second holding element, said firstholding element comprising a communication amplification antenna, saidcommunication amplification antenna being able to be coupled to thedistal electrode of the capsule.

Such a communication amplification device offers the advantage of makingit possible to check that the autonomous implantable capsule isoperating properly as soon as it has been manufactured. In addition,while it is being prepared for implanting, the implantable capsule maybe tested and programmed without being taken out of its sterilepackaging.

According to various advantageous subsidiary characteristics:

-   -   the communication amplification antenna comprises at least two        moving parts that are mounted to move relative to each other,        and a spring element enabling the two parts to move relative to        each other in order to put the communication amplification        antenna in contact with the distal electrode of the capsule;    -   the communication amplification antenna is formed of a flexible        conductive part;    -   the first holding element comprises a receptacle in which the        communication amplification antenna is fastened and which        comprises a space enabling the distal electrode of the capsule        to be inserted in register with the communication amplification        antenna so as to be coupled to said communication amplification        antenna;    -   at its distal end, the capsule comprises an anchor screw        comprising turns, and in that the receptacle comprises a        shoulder against which the turns of the anchor screw of the        capsule come to bear;    -   the first holding element comprises an opening making it        possible to see the coupling implemented between the        communication amplification antenna and the distal electrode of        the capsule;    -   the first holding element and the second holding element are        table to be assembled together;    -   the first holding element and/or the second holding element        comprise(s) manipulation means;    -   the first and second holding elements comprise complementary        locking means that are suitable for keeping the first holding        element and the second holding element locked;    -   the first holding element and the second holding element        comprise manipulation means, the manipulation means of the first        and second holding elements being aligned in a horizontal plane        when the first and second holding elements are locked together,        and the manipulation means of the first and second holding        elements form an angle relative to each other when the first and        second holding elements are unlocked;    -   the first and/or the second holding element comprise(s) at least        one orifice through the wall of said holding element for the        purpose of allowing a fluid to pass into the amplification        device; and    -   the second holding element comprises a communication        amplification antenna suitable for being put into contact with        the proximal electrode of the capsule.

BRIEF DESCRIPTION OF THE DRAWINGS

An embodiment of the present invention is described below with referenceto the accompanying drawings, in which like references designateelements that are identical or functionally similar from one figure toanother, and in which:

FIG. 1 is an overall perspective view of an implantable capsule;

FIG. 2 is an overall perspective view of a communication amplificationdevice of the invention;

FIG. 3 is a detailed view of the various component elements of acommunication amplification device of the invention;

FIG. 4 is cutaway perspective view of a communication amplificationdevice of the invention;

FIG. 5 is a view of a communications antenna designed to be insertedinto the amplification device of the invention;

FIGS. 6a and 6b are views of a first holding element in an embodiment ofthe invention;

FIGS. 7a and 7b are views of a second holding element in an embodimentof the invention;

FIG. 8 is a detailed view of the various component elements of acommunication amplification device in a second embodiment of theinvention; and

FIG. 9 is a view of apparatus for testing and/or programming a capsuleinserted into a communication device of the invention.

DETAILED DESCRIPTION

An embodiment of the invention is described below.

With reference firstly to FIG. 1, an implantable capsule 10 is shown,which, in this example, is a pacemaker capsule that is an autonomous,i.e. a self-contained, capsule, and which comprises a capsule tubularbody 12, and a distal element 14 provided at its distal end with anchormeans 16, e.g. of the helical screw type, and with a distal electrode18.

The anchor means 16 in the form of a screw are formed by a left-handedhelically wound wire, and are mounted on an anchor support 20incorporating arrangements that make the anchoring irreversible. Theanchor means 16 are able to come into contact with the tissue of a wallof an organ of the patient.

In a particular embodiment of the autonomous capsule, said capsulecomprises an electrical insulation element 24 inserted between the body12 and the distal element 14 for insulating the distal element from saidbody.

The body of the capsule 12 houses a set of functional elements of thecapsule, in particular an electronics module and a battery, and it alsocomprises a proximal electrode 22.

FIG. 2 shows a communication amplification device 30 of the invention,in which device an implantable capsule 10, as shown in FIG. 1, ispositioned.

The communication amplification device 30 comprises a first holdingelement 32 and a second holding element 34 for holding the implantablecapsule.

The distal end of the capsule 10 is table to be inserted into the firstholding element 32, and the proximal end of the capsule is suitable forbeing inserted into the second holding element 34 of the communicationamplification device 30.

Said first holding element 32 comprises a communication amplificationantenna 36, which is able to be coupled to the distal electrode 18 ofthe capsule 10.

Thus, in accordance with the invention, firstly the capsule is held in acommunication amplification device and secondly the communicationamplification antenna 36 of the device is in contact with the distalelectrode 18 of the capsule in order to amplify the signal, inparticular the HBC signal, that is delivered by the autonomous capsule.

Thus, it becomes possible to communicate with the capsule from anexternal device, such as a monitor, before the capsule is implanted, inparticular when the assembly formed by the capsule and the amplificationdevice is in its sterile wrapping or packaging. It is thus possible tocheck that the capsule is operating properly and to program said capsulebefore performing the operation of implanting the capsule in thepatient.

The first holding element 32 and the second holding element 34 of theimplantable capsule are, for example, made of plastic. Each of the firstand second holding elements 32, 34 has a respective cavity 40, 42 asshown in FIG. 3, dimensioned to fit the outside dimension of the capsuleso as to hold the implantable capsule in the amplification device 30.

Such a fit, in particular of the cavity 40 of the first holding element32 relative to the distal portion of the capsule offers the advantage ofmaintaining the coupling between the distal electrode 18 of the capsuleand the communication amplification antenna 36 of the amplificationdevice.

The communication amplification antenna as coupled in this way to thedistal electrode of the capsule increases the length of the conductivepart constituted by the distal electrode, and thus makes it possible toincrease the radiation of the electric field into its surroundingenvironment.

In accordance with the invention, the communication amplification devicemakes it possible to communicate simply and safely with the autonomouscapsule when said assembly is placed in its sterile packaging, withouthaving to open the sterile packaging and manipulate the capsule.

As shown in FIG. 2, and in a particular embodiment, the first and secondholding elements 32 and 34 are able to be assembled together.

FIG. 3 shows the various elements of the communication amplificationdevice 30, namely the first and second holding element 32, 34, and thecapsule 10 coming to be inserted into the holding elements.

The second holding element 34 comprises a cavity 42 of shapecomplementary to the proximal portion of the capsule.

In the embodiment shown in FIG. 1 and in FIG. 3, the capsule 1 is ofcylindrical shape, and the cavity is thus of a cylindrical shape thatfits the proximal end of the capsule 10.

In a particular embodiment, in order to facilitate insertion of theproximal portion of the capsule into the second holding element 34, asignificant amount of clearance is present between the proximal portionof the capsule and the outline of the cavity 42 in the holding element34, e.g. about 2 millimeters (mm) of clearance. However, in the lowportion of the cavity, the amount of clearance between the proximalportion of the capsule and the low portion of the cavity is smaller sothat the proximal portion of the capsule is centered and held. Toachieve this, the low portion of the cavity fits relatively snugly overthe outside dimension of the proximal portion of the capsule. In anexample, the clearance present in the low portion of the cavity lies inthe range 0 mm to −0.1 mm.

The first holding element 32 also comprises a cavity of shapecomplementary to the distal portion of the capsule, in particular of acylindrical shape that fits the distal end of the capsule 10. Inaddition, this cavity has a depth such that the capsule is inserteduntil the distal electrode 18 of the capsule comes to be coupled to thecommunication amplification antenna 36 positioned in the first holdingelement 32.

In a particular embodiment, the first holding means comprise asignificant amount of clearance between the distal portion of thecapsule and the outline of the cavity in the holding element 32, e.g. 2mm of clearance. However, in the low portion of the cavity, the amountof clearance between the distal portion of the capsule and the lowportion of the cavity is smaller so that the distal portion of thecapsule is centered. To achieve this, the low portion of the cavity fitsrelatively snugly over the outside dimension of the distal portion ofthe capsule. In an example, the clearance present in the low portion ofthe cavity lies in the range 0 mm to 0.2 mm.

The difference in snugness of fitting described above between the firstand the second holding elements and the autonomous capsule enables thesurgeon to remove the first holding element from the capsule duringimplanting, while the capsule remains held by the second holdingelement, thereby enabling the surgeon to fasten the fitting device tothe capsule. This procures easy manipulation for the surgeon.

As shown in FIG. 1 and in FIG. 2, the first and/or second holding means32, 34 comprise(s) respective manipulation means 44, 46 so that the twoholding elements can be taken hold of easily by the surgeon. Forexample, the manipulation means 44 and 46 may be protuberancespositioned on either side of the body of each of the holding elements.

FIGS. 4, 6 a, and 6 b show an embodiment of the first holding element 32in detail.

The first holding element 32 comprises a receptacle 48, at the bottom ofthe cavity 40, in which receptacle the communication amplificationantenna 36 is fastened and which receptacle comprises a space enablingthe distal electrode 18 of the capsule to be inserted in register withthe communication amplification antenna 36 so as to be coupled to saidcommunication amplification antenna 36.

At its distal end, the capsule as shown in particular in FIG. 1comprises an anchor screw 16 comprising turns.

In an embodiment, in order to facilitate putting the distal electrode 18into contact with the communication amplification antenna 36, the firstholding element 32, in particular the receptacle 48 of said firstholding element, comprises a shoulder against which the turns of theanchor screw 16 of the capsule come to bear so as to move the turns ofthe anchor screw 16 closer together and so as to give improved access tothe distal electrode 18.

In particular, the receptacle has a cylindrical shape in which theshoulder is housed. The shoulder makes it possible to define a space, inparticular a hollow cylindrical space, into which the distal electrodecomes to be inserted. The space created by said shoulder issubstantially of the same diameter as the distal electrode.

For example, the distal electrode 18 of the capsule is dome-shaped, oris pointed, or is plane.

The communication amplification antenna 36 inserted into the firstholding element 32 comprises an end that is inserted into the spacecreated in the shoulder. The communication amplification antenna 36 ispositioned in such a manner as to come into contact with the face of thedistal electrode 18 of the capsule when the capsule is centered in thefirst holding element 32 in an embodiment.

FIG. 5 shows in detail an embodiment of the communication amplificationantenna 36.

The communication amplification antenna in the example shown comprisesat least two parts that are, for example, cylindrical, and that aremounted to move relative to each other to make it possible to put thecommunication amplification antenna 36 into contact with the distalelectrode 18 of the capsule on insertion of the capsule into the firstholding element 32, regardless of the length of the distal electrode 18of the capsule.

For example, to achieve this, a spring element is provided that enablesthe two parts to move relative to each other.

In another embodiment, the amplification antenna may be formed inone-piece and be constituted by a single, flexible, conductive part.

The springiness of the antenna may be procured by means of a flexibleblade or of a blade made of a flexible material, e.g. a flexibleconductor wire, or any other compressible means, so as to enable thecommunication amplification antenna 36 to be put into contact with thedistal electrode 18 of the capsule while the capsule is being insertedinto the first holding element 32, regardless of the length of thedistal electrode 18 of the capsule. For example, the antenna may also becoated with a flexible material such as silicone, it being possible forthe coating to give the antenna its springiness.

Preferably, the end of the communication amplification antenna 36 thatis in contact with the distal electrode is spherical in order to createcontact at a point with the distal electrode and in order to limit therisk of scratching on the covering of the distal electrode, thatcovering generally being of the titanium nitride (TiN) type.

The communication amplification antenna 36 may be mounted intight-fitting manner in the holding element. However, in otherembodiments, the communication amplification antenna 36 may be snuglyfitted, adhesively bonded, crimped, or welded in the first holdingelement.

As shown in FIGS. 2, 3, 6 a, and 6 b, the first holding element 32comprises at least one opening 50 making it possible to see the couplingimplemented between the communication amplification antenna 36 and thedistal electrode 18 of the capsule. This opening 50 makes it possible,in particular, to check the physical connection between thecommunication amplification antenna 36 and the distal electrode 18 ofthe capsule.

In a particular embodiment, the first and the second holding element 32,34 are designed such that they can be assembled together, in particularby a portion of one holding element being inserted into the otherholding element. To this end, the geometrical shapes, in particular ofthe body of the second holding element and of the body of the firstholding element must be complementary, e.g. with functional clearance of0.1 mm.

FIG. 2 shows the two holding elements as assembled together.

In order to keep the two holding elements securely assembled together,the first and second holding elements 32, 34 comprise complementarylocking means suitable for keeping the first holding element locked tothe second holding element.

In an embodiment, the locking means 52 of the first holding element areshown in FIGS. 6a and 6b and the locking means 54 of the second holdingelement are shown in FIGS. 7a and 7 b.

The locking means 52 of the first holding element 32 are, for example,constituted by a clip positioned on the inside wall of the cavity 40 inthe body of the holding element that receives the distal portion of thecapsule, and the complementary locking means 54 of the second holdingelement 54 are, for example, constituted by an opening, preferably athrough opening, of shape complementary to the clip and provided in thewall of the cavity in the body of the second holding element 54 thatreceives the proximal portion of the capsule.

In a particular embodiment, the first holding element comprise twoopenings on either side of the locking means, in particular the clip, soas to create a blade 56 that is elastically deformable, that extendsfrom the top of the cavity 40 to the low portion of the cavity, and thatis of width slightly larger than the width of the clip.

As shown in FIGS. 7a and 7b , the second holding element comprises atleast one groove 58 enabling the clip 52 of the first holding means toslide over a given length, namely the length of the groove, while thetwo holding elements are being assembled together.

Said at least one groove 58 of the second holding element is, forexample, positioned at 90° relative to the locking means 54 of thesecond holding element.

The groove 58 has a certain length so as to set the depth of assembly ofthe second holding element 34 inside the first holding element 32.

The first and second holding elements are assembled together using themethod described below.

The second holding element is assembled to the first holding element bycausing the blade(s) 56 on the first holding element 32 to slide in thegrooves 58 in the second holding element, by the clip co-operating withthe groove, until it reaches the end of the groove 58. Then, the firstholding element is turned relative to the second holding element untilthe respective locking means of the holding elements are caused toco-operate with each other, e.g. in order to cause the clip 52 on thefirst holding element to co-operate with the corresponding opening 54 inthe second holding element.

The two holding elements are dissembled from each other in the reverseorder, i.e. by turning the first holding element relative to the secondholding element until the locking clip 52 co-operates with the groove 58in the second holding element, and then by moving the first holdingelement in axial translation relative to the second holding element.

In a variant embodiment, the two holding elements are disassembled fromeach other merely by moving the first holding element in axialtranslation relative to the second holding element.

In addition, in order to guide the surgeon in manipulating thecommunication amplification device, the manipulation means are mutuallyaligned in a horizontal plane when the first and second holding elementsare locked together, and the manipulation means 44, 46 form an anglerelative to each other when the first and second holding elements areunlocked.

In an embodiment, the opening 54 formed in the second holding means, andable to receive the clip 52 of the first holding means, comprises bevelsexcept on its front face in order to increase the force necessary fordisengaging the locking clip 52.

As shown in FIG. 2, at least one of the holding elements, and preferablyeach of the holding elements, comprises at least one orifice 60 throughthe capsule-receiving wall of the respective holding element so as toenable fluid to pass through into the communication amplificationdevice, and in particular into the first and second holding means.

This is because, in order to decontaminate the capsule and the holdingelements, the assembled assembly is immersed into a decontaminationfluid. The orifices 60 present in the walls of the holding elementsallow the fluid to pass through over the entire capsule.

In a particular embodiment in which through orifices 60 are formed inthe bottom of the groove 58 of the second holding element, correspondingthrough orifices 60 are then formed in the wall of the first holdingelement, so that, once the holding elements have been assembledtogether, the orifices 60 formed at the bottom of the groove correspondsubstantially to the orifices 60 formed in the wall of the first holdingelement.

In a particular embodiment of the invention, the second holding elementsuitable for receiving the proximal portion of the capsule alsocomprises a second communication amplification antenna 62 able to be putin contact with the rear element of the capsule that supports theproximal electrode of the capsule, as shown in FIG. 8.

For this purpose, and in a particular embodiment, the secondcommunication amplification antenna 62 is positioned in the secondholding element and is kept on the axis along which the capsule 10 ispositioned.

Such a communication amplification device 30 making it possible toamplify the signal from the first electrode 18 and from the secondelectrode 22 of the capsule makes it possible to conduct effectivetesting on the capsule as inserted in the first and second holdingmeans.

In an embodiment, the second communication amplification antenna 62 issmaller than the first communication amplification antenna 36 that isable to be connected to the distal electrode, in particular since theproximal electrode 22 of the capsule has a larger surface area, of about40 mm² and also a larger width, compared with about 2 mm² for the distalelectrode 18.

FIG. 9 shows testing and/or programming apparatus 64 for testing andprogramming the capsule as inserted in a communication amplificationdevice 30 of the invention.

This testing and/or programming apparatus 64 comprises an externalmonitor 66 to which two communication electrodes 68 and 70 areconnected. The communication electrodes 68 and 70 are spaced apart byabout 20 mm and are inserted in an electrode support 72 in order toachieve effective positioning of the capsule as inserted in theamplification device above the communication electrodes.

In an embodiment of the testing and/or programming apparatus 64, thecommunication electrodes 68 and 70 are of substantially square areahaving sides of 25 mm.

If, in a given example, it is considered that the testing and/orprogramming apparatus 64 comprises a receiver that is sensitive to alevel of emitted signal of −100 dB/emitted signal, then coupling of inthe range −60 dB to −80 dB is sufficient for good communications betweenthe testing and/or programming apparatus 64 and the capsule 10 asinserted in the communication amplification device 30.

Tests have shown that an antenna length of in the range 10 mm to 20 mmis sufficient to provide the communication distance of 30 mm between thecapsule as inserted in the communication amplification device and thecommunication electrodes.

The FIG. 9 shows such testing and/or programming apparatus 64 on which acommunication amplification device incorporating a capsule and aspositioned in a sterile bag 74 is positioned at a distance of about 3 mmfacing the communication electrodes.

1.-12. (canceled)
 13. A communication amplification device for animplantable capsule, in particular for a pacemaker autonomous capsule,the capsule comprising, at its distal end, a distal electrode structuredto come into contact with the tissue of a wall of an organ of a patient,said communication amplification device comprising: a first holdingelement and a second holding element configured to hold the implantablecapsule, wherein the first holding element is configured to receive thedistal end of the capsule and the second holding element is configuredto receive the proximal end of the capsule, and wherein the firstholding element comprises a communication amplification antennaconfigured to couple to the distal electrode of the capsule.
 14. Thecommunication amplification device of claim 13, wherein thecommunication amplification antenna comprises at least two moving partsthat are mounted to move relative to each other, and a spring elementenabling the two parts to move relative to each other such that thecommunication amplification antenna is configured to contact the distalelectrode of the capsule.
 15. The communication amplification device ofclaim 13, wherein the communication amplification antenna is formed of aflexible conductive part.
 16. The communication amplification device ofclaim 13, wherein the first holding element comprises a receptacle inwhich the communication amplification antenna is fastened and whichcomprises a space configured for insertion of and coupling to the distalelectrode of the capsule.
 17. The communication amplification device ofclaim 16, wherein the receptacle comprises a shoulder against whichturns of the anchor screw of the capsule are configured to come to bear.18. The communication amplification device of claim 16, wherein thefirst holding element comprises an opening making it possible to see thecoupling configured to be implemented between the communicationamplification antenna and the distal electrode of the capsule.
 19. Thecommunication amplification device of claim 13, wherein the firstholding element and the second holding element are able to be assembledtogether.
 20. The communication amplification device of claim 13,wherein the first holding element and/or the second holding elementcomprise(s) manipulation elements.
 21. The communication amplificationdevice of claim 13, wherein the first and second holding elementscomprise complementary locking elements structured to keep the firstholding element and the second holding element locked.
 22. Thecommunication amplification device of claim 21, wherein the firstholding element and the second holding element comprise manipulationelements, the manipulation elements of the first and second holdingelements being aligned in a horizontal plane when the first and secondholding elements are locked together, and the manipulation elements ofthe first and second holding elements form an angle relative to eachother when the first and second holding elements are unlocked.
 23. Thecommunication amplification device of claim 13, wherein the first and/orthe second holding element comprise(s) at least one orifice through thewall of said holding element for the purpose of allowing a fluid to passinto the amplification device.
 24. The communication amplificationdevice of claim 13, wherein the second holding element comprises acommunication amplification antenna configured to contact a proximalelectrode of the capsule.